[The immunologically-caused early abortion]

Recent advances in the understanding of immunological events during pregnancy offer new diagnostic and therapeutic approaches to couples suffering from unexplained recurrent spontaneous abortion. In terms of immunology the success of pregnancy means, that the fetus as a semi-allogeneic graft is not rejected by the mothers/recipients immune system. Beside a variety of specific and non-specific mainly locally acting substances a process of active tolerance induction is responsible for fetal survival. In response to paternally inherited fetal antigens the maternal immune system produces so-called blocking factors. In most women with unexplained recurrent spontaneous abortion these blocking factors cannot be detected. By immunization with paternal or third party lymphocytes the maternal immune system can be stimulated to produce blocking factors and therefore to protect a conceptus from rejection.

[A comparison of the course of anesthesia using a bolus application of propofol, methohexital or etomidate as hypnotics and alfentanil analgesia]

The suitability of the analgesic-hypnotic combination alfentanil-propofol in nitrous oxide-oxygen IPPB for short-term and outpatient anesthesia was studied in 50 patients of ASA risk groups I and II. This study appeared pertinent since the two substances have the shortest half-lives of their respective classes of medication. For comparison, two groups of similar size were treated with the well-established combinations alfentanil-methohexital and alfentanil-etomidate. During the entire intra- and postoperative periods the circulatory parameters were frequently monitored as was the continuous recording of the compressed spectral array in the EEG. Thirty minutes after extubation three modified tests of recovery were carried out that were compared to the preoperative results. For a subjective evaluation, a multiple choice questionnaire was answered by each patient after the recovery tests. The mean duration of anaesthesia in all three groups was 1 h. All three combinations were found to be agreeable to the patients with the best results in the propofol group. These patients also showed the most rapid recovery; consequently, the combination of alfentanil and propofol would appear to be especially suitable for outpatients. For the induction of anesthesia alfentanil was administered in a dosage of 30 micrograms/kg body weight in combination with propofol 1.5 mg/kg, methohexital 1.0 mg/kg or etomidate 0.2 mg/kg. For anesthesia maintenance the following mean dosages were found to be suitable: Alfentanil 1 microgram/kg/min, propofol 46 micrograms/kg/min, methohexital 24 micrograms/kg/min, and etomidate 4 micrograms/kg/min.(ABSTRACT TRUNCATED AT 250 WORDS)

[Immunologically-induced abortion--diagnosis and therapy]

As etiological factors responsible for repeated miscarriages disturbances of the maternal-fetal immunoregulation are involved. Diagnostic aspects of the immunobiology of abortion and the clinical management of habitual abortion by immunotherapy are discussed.

Pregnancy-maintaining antibodies: workshop report (Giessen, 1988)

To analyse the nature of antibodies which are purported to be essential for the maintenance of normal human pregnancy, six centers participated in a workshop of "blind" tests on 19 allosera. Fc-receptor dependent assays detected antibodies with specificity only for HLA. In addition to cytotoxic antibodies, the Fc-receptor dependent immune phagocytosis inhibition test revealed two non-cytotoxic alloantibodies with HLA specificity. These antibodies had high titers and may, therefore, be essentially non-cytotoxic. Murine monoclonal antibodies to HLA-A, B, C or DR (W6/32 and 2MC3) were used to evaluate the methods. These antibodies inhibited immune rosette formation as well as immune phagocytosis. Diluted to concentrations below the threshold of complement-dependent cytotoxicity, the monoclonal antibodies still inhibited the mixed lymphocyte reaction and the immune phagocytosis. A human monoclonal immunoglobulin M with specificity for monomorphic non-HLA lymphocyte antigens inhibited the mixed lymphocyte reaction. The immune rosette inhibition test exhibited several false positive reactions, e.g. three out of four with a serum that did not contain alloantibodies to blood cells. Non-cytotoxic antibodies were therefore rare in the selected sera of the workshop and they exhibited HLA specificity only. No participant was able to identify pregnancy-maintaining non-HLA-antibodies.

[The effect of metoprolol on fenoterol-induced kidney function disorders]

The effect on renal function of a combination of a beta 2 receptors stimulating tokolytic agent (Fenoterol) with a so-called cardioselective beta 1 blocker (Metoprolol) which is able to antagonise the cardiac side effects of beta 2 stimulation, was examined in femaLe rabbits in a 24-hour test. Infusing 31.5 ml/h isotonic solution, 20 micrograms/kg/min Fenoterol and 3.125 micrograms/kg/min Metoprolol, excretion, creatinine clearance, electrolyte elimination, the serum electrolyte levels, Hb, HK and the weight were determined. The combination of Fenoterol and Metoprolol antagonised almost completely the massive water retention occurring under Fenoterol alone. At the latest after 12 hours, normal values were obtained in respect of the creatinine clearance reduced under Fenoterol, the urine excretion rate and, consequently, the Hb concentration and haematocrit reading. The reduction of sodium elimination caused by Fenoterol was completely reversed under the combination, whereas the reduced excretion of potassium was not influenced. Water retention in tocolysis with beta 2 stimulants is one of the most important causes for the information of a pulmonary oedema. The danger of the occurrence of such pulmonary oedemas, especially in risk pregnancies (gestosis), is drastically reduced by antagonising water retention, and hence the combination of Fenoterol and Metoprolol seems to be very favourable from both the cardiac and renal viewpoints. In a group of 17 pregnant women, the drastic improvement of urine excretion under the combination could be confirmed.